STATE OF OREGON Corporation Division UCC 255 Capitol Street NE, Suite 151 Salem, OR 97310-1327 503-986-2200 Fax: 503-373-1166 FilingInOregon.com
(Reserved for Filing Officer Use)
CERTIFICATE OF SATISFACTION OF DISCHARGE OF GRAIN PRODUCERS LIEN
PURSUANT TO ORS 87.777 PLEASE TYPE OR PRINT LEGIBLY.
A. THIS STATEMENT REFERS TO ORIGINAL STATEMENT Grain Lien File No.: B. DEBTOR NAME (IF INDIVIDUAL, LIST LAST NAME FIRST). Name Address City C. NAME OF CLAIMANT Name The undersigned certifies and declares with respect to the notice of claim of grain producers lien filed in the office of the Secretary of State that the debt secured thereby is fully paid and satisfied and is discharged. The undersigned acknowledges this to be the undersigned's signature and voluntary act. If the undersigned is a corporation, it has caused its corporate name to be signed by officers duly authorized by its board of directors. Date: Claimant Name: Claimant Signature: State Zip Date Filed:
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No Fee is required to file this form.
Submit completed form to: Corporation Division UCC 255 Capitol Street NE, Suite 151 Salem, Oregon 97310-1327
451 (Rev. 02/07)